Pain Management in Acute Care Settings among the Elderly and Drug Users
Problem Description and Context
Pain management is an area of growing concern not just in the peri-operative period but also when it comes to older persons and drug addicts. The two categories of individuals present a lot of challenges for pain practitioners when it comes to acute pain control in the acute care settings. Macintyre & Schug, (2014) affirm that the elderly have comorbid medical conditions which predispose to poly-pharmacy that result in drug interactions and resistance. Research shows that a single old patient takes at least nine medications per day which predisposes to adverse drug reactions.
Drug pharmacokinetics also changes with age due to natural physiological changes in addition to the declining physical and medical function (Tracy & Morrison, 2013). The failing body organs at an old age such as liver and kidneys predispose to drug toxicities among the elderly due to reduced drug excretion (Abdulla et al, 2013). The elderly also face a unique set of challenges in pain management since the core strategies of pain management such as exercise and stretching may not work due to physical limitations.
Drug addicts face similar problems in pain management since opioids are the most commonly abused drugs yet they are commonly prescribed for pain. The victims of drug addiction cannot achieve adequate pain control using opioids since they have developed tolerance to the drugs and may require extremely high doses. Clinicians are mandated to meet the healthcare needs of all patients, yet it is hard to distinguish real addiction, physical dependence and pseudo-addiction among the drug users (Garland et al, 2014). The stigma associated with the label of drug seeking or an addict may also bar the drug addicts from seeking pain medication even when they are in pain.
Impact of the Problem
The challenges posed by the pain management among the elderly and drug addicts affect the process of pain control. Nurses may not achieve adequate pain management for this category of individuals given that they could have drug resistance or even drug interactions. The drug addicts and elderly may need higher doses of pain medication given that their bodies have already become tolerant to the drugs in the drug users and a reduced distribution among the elderly. Buchanan, Geerling & Davies (2014) state that chronic pain is expensive and leads to disability and absence from work and is among the leading causes of mortality in chronically ill patients. The quality of life of the patients will be lowered given that ineffective pain management worsens the condition of the patient in addition to the disease pathophysiology.
Significance and Implications to Nursing
Pain management is one of the primary priorities of nurses in the management of patients with chronic illness. Nurses recognize the fact that chronic pain is associated with a lowered quality of life hence the need to intervene as appropriate to alleviate the pain. The elderly and drug addicts pose a unique challenge to nurses who need to reconsider and use evidence-based practice to manage their suffering. Nurses may fail to achieve adequate pain control among the elderly and drug addicts, yet it is the right of every patient to achieve adequate pain management (Molton & Terrill, 2014). Nurses may, therefore, face litigation and other disciplinary measures yet the unique features of the elderly and drug users predisposed them to drug tolerance.
Proposed Solution
Individual assessment of pain should be done, and a customized plan of care implemented to handle the pain. People are different, and response to pain is variable hence it is the role of the nurse to carry out an individualized assessment for each patient (Davis, 2016). Organ function tests should be conducted before the administration of the pain drugs to determine whether the patients will tolerate the medication. Research should also be done to incorporate the best pain management strategies in the alleviation of pain in addition to clinical expertise. Galanter et al. (2014) state that a non-judgemental approach should be assumed when dealing with the drug addicts since the priority at that time is pain management.
References
Abdulla, A., Adams, N., Bone, M., Elliott, A. M., Gaffin, J., Jones, D., … & Schofield, P. (2013). Guidance on the management of pain in older people. Age and ageing, 42, i1-57.
Buchanan, A., Geerling, J., & Davies, A. (2014). Breakthrough cancer pain: the role of the nurse. International journal of palliative nursing, 20(3).
Davis, K. (2016). Pain management. Pain.
Galanter, M., Kleber, H. D., & Brady, K. (Eds.). (2014). The American Psychiatric Publishing textbook of substance abuse treatment. American Psychiatric Pub.
Garland, E. L., Manusov, E. G., Froeliger, B., Kelly, A., Williams, J. M., & Howard, M. O. (2014). Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial. Journal of Consulting and Clinical Psychology, 82(3), 448.
Macintyre, P. E., & Schug, S. A. (2014). Acute pain management: a practical guide. CRC Press.
Molton, I. R., & Terrill, A. L. (2014). Overview of persistent pain in older adults. American Psychologist, 69(2), 197.
Tracy, B., & Morrison, R. S. (2013). Pain management in older adults. Clinical therapeutics, 35(11), 1659-1668.
